To order one of our featured Specials or many other quality products, complete our Order Form below, click on Contact Us or send us an E-Mail.

Mobility Unlimited is an authorized dealer/distributor for numerous manufacturers of quality durable medical equipment and medical/surgical supplies. While not all-inclusive, the list of independent living aids/products shown on our Products web page is indicative of the breadth of products we carry and the manufacturers we represent.

To place an order, please read the Terms, Conditions, and Warranty and complete the form below in its entirety. Typing your name in the Signature block and clicking the “Place Order” button confirms your acceptance of these terms.

Thank you for choosing Mobility Unlimited to serve you. We appreciate your order.

This order is entered this day of (month), 2002 between and

by the following entity/ person and Mobility Unlimited :

Authorized Person:
Company Name:
Street Address 1:
Street Address 2:
City:
State or Province:
Country (if outside the USA):
Zip Code or Postal Code:
Telephone No. (incl. area code):
FAX No. (incl. area code):
E-Mail Address:

 

life enhancement product being ordered:		Cost US$
product description
model name / item number:
size or color:
option 1 description:
option 2 description:
option 3 description:
	SUBTOTAL before tax:
	Florida residents 6% sales tax:
	shipping and handling:
	TOTAL ORDER:

 Method of Payment:

Check / Cheque:

A check / cheque will be enclosed with the
order form for the above TOTAL ORDER:

Credit Card

Card Type: VISA Master Card Discover 

Credit Card Number

Credit Card Expiration Date

Cardholder’s Name (exactly as it appears on card)

AGREEMENT TO TERMS

I have read and agree to the Terms, Conditions, and Warranty.

User Signature (Required)

Date of Transaction (Required)

To reset this Order Form, you must click “RESET FORM” above and then use your web browser’s “RELOAD” button.

Typing your name in the “User Signature” field above and selecting the “Place Order” button authorizes the immediate processing of your order as per the above Details of Order and Agreement To Terms. Please review with care the information you have provided above and select “RESET FORM” if you need to clear the form and start over. If you have any questions, please contact us at questions@mobilityunlimited.com or call us at the number listed at Contact Us.

Thank You for Your Order.

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